Fertility and UFE

Because of the
very real potential for any one of the following items to occur, most interventional
radiologists do NOT recommend uterine fibroid embolization for women wishing
to retain their fertility for future childbirth except under special circumstances.

1.

Shared blood
flow from uterine to ovarian artery or vice versa (results in embolization
of the ovary and menopause OR leading to possible failure of the UAE to
treat the fibroids). This phenomenon is called anastomoses.

2.

Misembolization
of ovarian artery (resulting in menopause).

3.

Infection
requiring hysterectomy.

4.

Complete
necrotization of the uterus (resulting in hysterectomy).

5.

"Problems"
with the endometrium (possibly reduced blood flow) that interferes with
implantation of eggs.

Yes, these are
all very real potential consequences of uterine fibroid embolization.
Items 1-3 have already occurred and are well documented. Items 4-7 are all
theoretically possible but have not been documented as having occurred as
yet. Publishing in a medical journal can take as long as 6 months to a year--sometimes
longer, however.

On 2/25/97,
Dr. Harold Mitty submitted a case review of 12 women who had undergone
emergency UAE in 1990-1995. He specifically looked at the impact of
UAE on menses and pregnancy and reported 3 women as having conceived
post UAE.

In Europe,
J H Ravina "officially" reported the results of his 1993+ studies on
uterine artery embolization on July 28, 1997 and it was subsequently
published in La Press Medicale in France on 2/21/98. As part of that
paper he reported 4 patients who became pregnant. Two miscarried, 1
had twins via c-section, and 1 gave birth to a full-term normal baby.
All born prior to7/28/97
-- the date his paper was accepted for publication.

In addition,
uterine artery embolization has been around for over 20 years and I'm
quite certain that many other, undocumented, "unofficial" cases of pregnancy
have occurred post UAE. Probably hundreds--maybe more.

Ms. Snyderman
grossly exaggerated and elevated Leslie Miles' case from being the first
"officially" reported in the United States to being the first in the
world. Isn't it incredible how quick and easy it is to transmit misinformation
to millions of people? Thanks to what I know about UFE compared to ABC's
presentation of this story, I will never, EVER trust medical information
presented on popular TV again.

Also, keep in
mind that information on incidents such as those listed above are not always
openly shared or published. (Actually, this is a true statement regardless
of the medical procedure involved.)

A single uterine
rupture resulting in hysterectomy has occurred in England. This case involved
an infarcted fibroid and the woman was NOT pregnant at the time. As
it stands, until such a case is officially reported, it can only be
speculated that uterine rupture is a possibility during a term
pregnancy post UFE.

Early onset of
menopause is also troublesome in terms of fertility because a European panel
recently reported that as many as 10% of women undergoing UFE have entered
into menopause within one year post procedure. Researchers in the United States
are now reporting a "rough" figure of 5%. However, more long-term
studies are required to determine whether this is truly a collateral result
of the UFE or a natural occurrence due to the age of women undergoing this
procedure.

Regardless of
all of the above concerns, ABC Good
Morning America chose to broadcast a rather glowing report on fertility
retention with UFE. Yes, there have been a dozen or so successful pregnancies
and the women this has happened to are, by and large, ecstatic.

Before walking
down this path, however, you may want to consider the risks very carefully
and compare them against the risks of other procedures for treatment of your
uterine fibroids. In addition, you might want to consider the use of gelfoam
instead of polyvinyl alcohol particles as this embolic material has been speculated
as showing potentially less permanency and possibly bears less
risk towards preventing pregnancy entirely over the remainder of your childbearing
years.